Clinical Looking Glass

NEW YORK – Montefiore Medical Center in New York’s Bronx borough has been providing quality care for decades, thanks to a clinical analytics system that could serve as a model for other healthcare systems across the country.

Called Clinical Looking Glass, or CLG, the technology is the brainchild of Eran Bellin, MD, vice president of clinical IT research and development at Montefiore.

Academic centers do critical research, but not without a programmer and researchers. The critical distinction with Montefiore’s technology is that it is readily accessible to doctors. It was built that way with the intention, said Bellin, to democratize the process.

“That is, it wasn’t enough to have one or two priests in the institution be able to do the analysis,” he said, “but rather, we wanted to distribute this capability widely – with obviously patient privacy protections – to other members of the medical community so that they could participate in quality improvement activities that were necessary to continually improve the process of care here.”

“You don’t have to be a programmer,” he said. “You don’t have to be an epidemiologist to be able to use this tool.”

Montefiore has trained more than 800 people to use the system – physicians and first-year residents, in two- or three-hour sessions.

“This remarkable software taps into the large pool of electronic medical record data collected over the past decade,” said Steven Sayer, MD, Montefiore’s president and CEO. “While EMRs have the ability to improve quality and reduce costs for single patients, CLG interprets this data for entire patient populations so that we can rapidly check the collective effectiveness of patient safety measure, conduct clinical research and even comply with federal regulations.”

Safyer says the software offers a glimpse of how healthcare informatics is shaping the future of medicine.

Montefiore employs a GE Carecast system.

“None of the available systems that were out there – and even today there aren’t any systems out there – can do the complex, temporal relationships that we can do,” said Bellin. Many of the questions that doctors had were simply unanswerable before CLG. Today, the Accountable Care Organizations called for by the government are raising some of the same questions, he said, as they work to measure and improve care.

Analytics software is geared to the business world, he said, and can’t easily transfer to the clinical side.

Clinical analytics demands a different approach.

“When you think about a bank or a financial institution, they want to know how much money they have in January and February and March and April,” Bellin explained. “They don’t care where those dollar bills came from. They want to know how much do we have in bucket A, bucket B, bucket C. Really, the trajectory of that dollar bill – watching it over time every single day – is not of interest.

“If you have a group of patients a year ago that had high blood pressure, you want to know what percentage of those got under control by January, by February, by March, by April. That trajectory of change, that trajectory of control, is absolutely critical to know how well you’re managing the patient.

Obviously you don’t want to have a patient have high blood pressure for five years before you bring it under control.”

Sofiya Milman, MD, a fellow in the Division of Endocrinology at Montefiore, said the technology is invaluable.

“Clinical Looking Glass allows me to collect and analyze clinical information on thousands of patients with diabetes with just a few clicks of a mouse, resulting in a better understanding of the impact that this disease has on individuals and communities,” she said. “This would not have been achievable without CLG.”

The South Bronx Health Center uses CLG to improve the quality of care for its patients, said Alan Shapiro, MD, senior medical director for community pediatric programs at Children’s Hospital at Montefiore. For example, he said, it’s used to identify poorly controlled diabetics and target them for outreach.

“The results have been outstanding,” Shapiro said. “In five key clinical NCQA diabetes measures the SBHC consistently surpasses national benchmarks for both Medicaid and commercially insured patients – achieving its mission in improving the health status of the community served and closing the gap in health disparities.”

Business analytics tools don’t zero in on the trajectory of outcome, which a doctor would naturally do, said Bellin.

“A doctor sees you in his office, and it could take three weeks to get you under control,” he said. “So he’s actually monitoring you on an ongoing longitudinal basis to see what’s happening to you. Any analytic you build should actually do the same thing that the doctor does – it just should do it on a thousand patients.”

Bellin said the tools available today (“We call them slices and dices,” he said) slice and dice in calendar time.

“That’s not the way doctors look at it,” he said, “nor the way patients experience their healthcare. CLG allows all clinicians and hospital administration to test hypotheses that just a few years ago would have been impossible to do.”

“To be able to identify, within minutes, a cohort of patients, qualify them by a specific disease, medication, clinical event, race, time period or neighborhood provides a new paradigm for population-based medicine and a new level of importance for healthcare informatics,” he said.

He likens Clinical Looking Glass to night vision.

“The Army, before, when it got dark, you couldn’t fight a war,” he said, “but now you have night vision. Well, it’s the same thing in healthcare. Without a tool like Looking Glass you have no idea what’s going on out there. Now you can actually see the entire field, and you can see it in the dimension of time as well. You can actually see whether the patient is getting better or not.”